MEDICARE: KELLI RASCHEL GRAY-MEISNER R.D.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	917024	CA

General Provider Information

NPI Number	:	1598158123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI RASCHEL GRAY-MEISNER R.D.N

Provider Business Mailing Address
First Line	:	PO BOX 232410
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-2410
Country	:	US
Telephone Number	:	858-249-6748
Fax Number	:	619-543-3183

Provider Business Practice Location Address
First Line	:	2719 HIGHLAND AVE
Second Line	:	APT B
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-7462
Country	:	US
Telephone Number	:	619-861-5477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2015
Last Update Date	:	05/11/2017

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